Gallbladder polyps and primary sclerosing cholangitis

Presentation

Previous diagnosis of ulcerative colitis. Presents with elevated liver enzymes.

Patient Data

Gender: Male
Ultrasound

Transabdominal ultrasound of the gallbladder

There are multiple polypoid lesions of the gallbadder measuring over 10mm.

There are multiple polypoid lesions of the GB. No extramural invasion to indicate malignancy. 

Diagram

Management and follow-up of gallbladder polyps

This chart is a summary of management of GB polyps from the publication listed in the references below 1.

Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).

Case Discussion

The US and MRI demonstrate multiple large polyps without evidence of invasion.

 MRCP demonstrates multiple intrahepatic and extrahepatic biliary strictures consistent with multifocal cholangiopathy. In a patient with UC, this is in keeping with primary sclerosing cholangitis (PSC).

The management and follow-up of gallbladder polyps is controversial and practice varies between centres. However, due to the increased risk of malignancy, two clear indications for surgical referral for consideration of cholecystectomy are: 

  • size is 10mm or greater
  • high-risk patients (including patients with PSC) with polyps 5mm or greater 1

This patient went on to have a cholecystectomy which demonstrated T1a N0 cancer within the gallbladder polyps. 

Case courtesy of Dr Jamie Franklin and Dr Ed Godfrey on behalf of the British Society of Gastrointestinal and Abdominal Radiology.

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Case information

rID: 52527
Case created: 11th Apr 2017
Last edited: 15th May 2017
Inclusion in quiz mode: Included

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